12) DIABETES MEDICATIONS
c) List of Potential Medications
The oral drugs a physician might prescribe include:
1) Thiazolidinediones (Glitazones)
a) Rosiglitazone (Avandia™)
b) Pioglitazone (Actos™)
These drugs help insulin work more efficiently by lowering insulin resistance, allowing blood sugar to either move into muscle cells for energy or into fat cells for storage. They are normally taken once or twice daily with food. Their side effects include a very rare but serious liver condition so a liver profile will be taken by any physician prescribing these for any length of time. Any person taking these drugs should call their physician immediately if they have any signs of liver disease, which include yellowing of the whites of the eyes or the skin, lack of appetite, tiredness, nausea, vomiting, stomach pain, or dark-colored urine. Rare side effects include anemia and swelling of the feet and ankles. As with many diabetes drugs, these drugs can commonly cause weight gain so food intake needs to be controlled to keep weight down and prevent heart disease. These drugs can be taken with insulin.2) Biguanides
a) Metformin (trade names: Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others, this is now a generic drug so there are many formulations including extended release forms)
This drug is very useful in that it works via several different routes. It sensitizes the cells in the body to the insulin already present and it helps lower blood sugar by making sure the liver doesn't release too much carbohydrate from its stores. An individual may lose a few pounds when they start to take metformin (due to the side effects) but metformin shouldn't be considered a weight loss drug. Metformin can also improve blood fat levels, which are often high in individuals with Type 2 diabetes. This drug is normally taken two to three times each day with a meal (the extended release forms avoid this difficulty). Side Effects: Metformin can make a person sick if they drink more than about two to four alcoholic drinks a week. Metformin can build up in the body if a person has kidney problems. Metformin can cause vomiting and diarrhea (diarrhea occurs initially in upwards of 50% of people taking this drug but is typically mild and stops in a few weeks). Rarely individuals on metformin can have weakness and difficulty breathing. This requires emergency medical attention. Any surgery generally requires an individual to stop taking metformin several days before the surgery, especially if any dyes are used, such as in an angiogram. This drug can be taken with insulin.3) Sulfonylureas:
a) Chlorpropamide (Diabinese™) Long acting
b) Glipizide (Glucotrol™) Intermediate acting
c) Glyburide (DiaBeta™/ Micronase™/Glynase™) Intermediate acting
d) Glimepiride (Amaryl™) Intermediate acting
e) Acetohexamide (generic)
f) Tolbutamide (generic) Short acting
g) Tolazamide (generic)
These drugs stimulate the beta cells in the pancreas to release more insulin over a period of 8 to 24 hours. Obviously if an individual's type 2 diabetes has progressed to the point that their pancreas makes little or no insulin and they are injecting insulin, then this class of drugs won't work too well. These drugs are generally taken one to two times daily, generally just before meals. Side effects can include: low blood sugar (hypoglycemia which gives shakiness, mental disorientation, dizziness, and sweats), upset stomach, skin rash, itching and weight gain. Some experts discourage the frequent use of these drugs in even non-insulin dependent type 2 diabetes because they stimulate an already failing pancreas.4) Meglitinides
a) Repaglinide (Prandin™)
b) Nateglinide (Starlix™)
These drugs work with similar action to sulfonylureas, except they are fast and short acting, generally only stimulating insulin production in the pancreas for one to two hours. These drugs are taken 30 minutes to just prior to each meal. They don't work where an individual has stopped producing insulin and is on insulin injections. A good thing about meglitinides is that they work fast and the effect doesn't last too long. This rapid action means an individual can vary the times they eat and the number of meals they eat more easily than they can with other diabetes medications. Since they are so short acting the major side effect is the rapid onset of low blood sugar, especially if a patient skips the planned meal. Some experts discourage the frequent use of these drugs in even non-insulin dependent type 2 diabetes because they stimulate an already failing pancreas.5) Alpha-glucosidase inhibitors
a) Acarbose (Precose™)
b) Miglitol (Glyset™).
These medications block the enzymes that digest the carbohydrates ingested. This reduces the blood sugar levels. Typically these drugs are taken at meals where carbohydrates such as starch are going to be eaten. Since this medication prevents the digestion of some carbohydrates in the small intestine, bacteria in the large intestine can digest it, causing gas, diarrhea and bloating. This will normally pass after a few weeks. Often times a physician will start out with only one dose per day and work up to three doses over a month or two months. This medication can help with weight lose as it prevents the absorption of some of the calories eaten.6) DPP-4 inhibitors
a) Sitagliptin Phosphate (Januvia™)
DPP-4 inhibitors work by stimulating the production of hormones called incretins. When blood sugar is elevated, these hormones work in two ways to help the body regulate high blood sugar levels: they trigger the pancreas to increase the release of insulin and signal the liver to reduce its production of blood sugar. This drug is typically taken once per day. This drug is relatively new and is typically only used when the patient is not using insulin. Side effects include upper respiratory infection, sore throat and headache.7) Exenatide (ByettaTM)
Byeta is taken by injection twice a day. Byetta improves blood sugar control by mimicking the action of the hormone incretin. When blood sugar is elevated, Byetta works to help the body by increasing the release of insulin and signaling the liver to reduce its production of blood sugar. The most common side effect of Byetta is mild to moderate nausea, which improves with time in most people. Rarely, Byetta may cause harmful inflammation of the pancreas (pancreatitis). Byetta slows down the movement of food out of the stomach and tends to prevent people from eating too much. Byetta thus tends to promote weight loss.Diabetes medication advice should only be given by a legitimate medical physician after a complete blood work-up. Such advice should also not be given by some "herbal remedy" circular that comes to your house through the mail, not by an internet email advertisement, and not even by an advertisement in a legitimate magazine (there is a real problem with drug suppliers going around physicians directly to the patients with advertisements). Only medical physicians have the comprehensive knowledge required to know what medication is best for any given set of circumstances. Depend on your physician for advice on the proper medication mix for you. Note that new medications are coming on the scene every year and only physicians have good access to these new medications.
Current Chapter: 12) DIABETES MEDICATIONS
a) Introduction
b) Diabetes Medications
c) List of Potential Medications
d) Insulin Injections
e) Blood Sugar Testers
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